Radioembolization for the treatment of unresectable liver cancer: initial experience at a single center

Radioembolization with yttrium-90 microsphere (Y-90) therapy with SIR-Spheres (Sirtex Medical, Lane Cove, Australia) was approved by the Turkish Ministry of Health in April 2008. In this study, we present the preliminary experience at a tertiary care center with early follow-up results of Y-90 therapy, as well as a review of the related literature.

Complete evaluation for radioembolization was performed in 10 patients (8 males, 2 females; mean age, 52.3 years) during an 8-month period at a single center, of which 9 were actually treated with SIR-Spheres(R). All patients underwent meticulous pre- and post-procedural imaging studies to document the therapy response. RESULTS; In order to isolate the target hepatic arterial circulation, following branches were embolized as they were considered as potential gastrointestinal shunts: the gastroduodenal artery (n = 5), right gastric artery (n = 1), and supraduodenal artery (n = 1). Radioembolization therapy could not be performed only in one patient because of a hepatogastric shunt of unknown origin. No significant hepatopulmonary shunting was identified (maximum, 9% shunting). The body surface area method was used to calculate the Y-90 dose in all patients (mean dose, 1.24 GBq). All patients had at least partial response of the targeted liver lesions, according to RECIST (Response Evaluation Criteria in Solid Tumors).

In comparison to chemoembolization, radioembolization has less systemic toxicity and can be performed as an outpatient procedure, which makes it more attractive to both patients and physicians. From our limited experience, the radioembolization procedure is a promising first-line treatment in unresectable liver cancer; randomized controlled multi-center studies, however, are needed.